Executives in healthcare administration: where do women stand?

Healthcare Financial Management, July, 1992 by Susan C. Borkowski, Ann Walsh

MANAGEMENT

The disparity in management responsibility and earning potential of men and women seen in business at large is mirrored in healthcare administration. While a variety of factors may influence this difference, a preliminary study of the career advancement of recent graduates of a healthcare administration graduate program suggests that recruitment and promotion policies may be largely responsible for gender disparities.

It would appear that a woman's prospects for a career in healthcare administration are encouraging, with more than 50 percent of recent graduates of healthcare administration master's degree programs being female, and female graduates' salaries being comparable with those of male graduates. However, experience has shown that opportunities to assume greater management responsibility and to attain higher salaries tend to shrink for women and expand for men as their respective careers progress. The majority of top management positions in healthcare administration are held by men, even though women outnumber men in the profession.

Moreover, a salary gap between similarly qualified men and women in healthcare administration positions begins to develop at higher management levels and has been shown to widen to more than $10,000 annually. Some reasons for this disparity and potential solutions to narrow the gender gap are the focus of this discussion.

Emergence of the professional

Until the mid-1930s, no university-affiliated educational programs were offered in the field of healthcare administration. Hospital administrators usually were promoted from within the institution, and physicians held management positions in 46 percent of the hospitals. Although physicians continued to exercise considerable influence in the management of hospitals during the subsequent 30-year period, new trends in the education of healthcare administrators began to emerge.

In 1929, the Davis report recommended the development of formalized educational programs for healthcare administration which would incorporate the standard principles of business administration into the curriculum. Six such graduate programs had been established in the United States by 1951, with many combining traditional academic classroom experience with a practical, hospital-affiliated residency.(a) By 1990, there were more than 150 healthcare administration programs at the graduate and undergraduate levels.

Hospitals generally provided the foundation for residency education until the early 1980s. Increased regulation and declining inpatient reimbursement, however, hastened the evolution of alternative delivery systems, and changed the educational requirements for healthcare administrators. Administrators of these new systems were required to understand the internal dynamics of hospital operations as well as the complexities of managing vertically integrated businesses." Consequently, recent reports on board/management relations emphasize the need to recruit managers who can plan strategically and design new products to ensure survival and profitability for the health system in the future.(c)

Women's role

With the exception of Catholic hospitals, the majority of which have been managed by communities of religious women, hospital administration is historically a male profession. Survey data compiled between 1979 and 1988 by the Association of University Programs in Health Administration indicate that in 1979 only 40 percent of the graduates of AUPHA-affiliated healthcare administration programs were women.(d)

The next decade saw the number of women entering graduate programs increase substantially; by 1988, women comprised 59.4 percent of program graduates entering the workforce. Despite this absolute growth in the number of female graduates, many top executive positions continue to be occupied by males.(e)

Theories for disparity

Differences in salary and career mobility have been addressed repeatedly in the professional literature as separate and distinct factors. Economic, organizational, and psychological theories have been developed to explain these issues and why they are treated as separate problems.

Economic theorists suggest that wage and career opportunity differentials may be attributable to interrupted employment cycles. Periods of employment inactivity due to child rearing, responsibility for aging family members, or involuntary unemployment inevitably affect career mobility and future earnings. Salary differentials and advancement, therefore, are perceived as a market response to a transient work history.(f)

In contrast, psychological theories suggest that career advancement and subsequent earnings are affected by the psychological attributes of the individual. Consequently, the ability to be a team player or to network effectively with others are cited as key ingredients for success within the organization.(g)

Finally, organizational theories emphasize the structural and behavioral dimensions within the organization that can affect mobility. This approach suggests that the centrality of a person's position to those in influence or the ability to acquire appointment to key organizational committees contributes to advancement.(h)